Thu11November0840AM 5

A 56-year-old woman with anaemia related to chronic renal failure comes to the Emergency department complaining of increased tiredness.

She is currently using EPO injections three times per week and is concerned that she requires an increased dose.

Investigations reveal:

Hb 90 g/L (115-160)

WCC 6.3 ×109/L (4-10)

PLT 185 ×109/L (130-400)

Na 136 mmol/L (135-145)

K 4.9 mmol/L (3.5-5.5)

Cr 235 µmol/L (70-120)

Ferritin 65 mcg/L -

Which of the following is the most appropriate intervention?

(Please select 1 option)

Arrange IV iron supplementation This is the correct answer

Increase the dose of EPO

Do nothing Incorrect answer selected

Increase the injection frequency of the EPO

Check transferrin saturation

Explanation

Although the patient is requesting a change in EPO dose, it is not appropriate given that the ferritin is below target (65 vs. a target level of >100). As such, the optimal next step is iron supplementation.

If the Hb fails to recover despite adequate ferritin, then a change in EPO dose can be considered.

Transferrin saturation can be useful if functional iron deficiency is considered in patients where the serum ferritin is >100 (saturation level <20% suggests that function iron deficiency may be present). EPO is ineffective in the setting of low ferritin, therefore both options which vary EPO dose are inappropriate.

Reference:

NICE Pathways. Anaemia of chronic kidney disease: ESA therapy.

Answer Statistics

1

32%

2

2%

3

14%

4

2%

5

53%

Times answered: 307